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Modeling of live-birth rates and cost-effectiveness of oocyte cryopreservation for cancer patients prior to high- and low-risk gonadotoxic chemotherapy.
Hum Reprod. 2017 10 01; 32(10):2049-2055.HR

Abstract

STUDY QUESTION

What is the live-birth rate (LBR) and cost-effectiveness of fertility preservation with oocyte cryopreservation (FP-OC) compared to expectant management in cancer patients age 25-40 based on estimated gonadotoxicity of treatments 5 years after cancer diagnosis?

SUMMARY ANSWER

Oocyte cryopreservation prior to cancer treatment is more costly, yet more effective (producing more live births), than not undergoing oocyte cryopreservation but it is most beneficial for patients undergoing high-risk chemotherapy (HRC).

WHAT IS KNOWN ALREADY

The decision to undergo FP prior to treatment is multifactorial and can be costly and delay treatment. Not all treatments carry the same gonadotoxicity and patients may choose to undergo FP-OC based on the probability of premature ovarian insufficiency, predicted outcomes and cost. A comprehensive model that incorporates age at diagnosis and toxicity of treatment to help guide patients in the decision to undergo FP-OC does not yet exist.

STUDY DESIGN, SIZE DURATION

This study used a Decision Analysis Model to estimate effectiveness and cost of FP for cancer patients.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Age-based estimates of LBR and cost per live birth were calculated for ages 25-40 years based on gonadotoxicity of treatment. A decision analysis model was constructed using Treeage Pro 2015 with case base probabilities derived from national registries, practice guidelines and medical records from a national network of infertility practices (IntegraMed).

MAIN RESULTS AND THE ROLE OF CHANCE

Compared to no FP-OC, FP-OC improved LBRs for women of all ages undergoing either low-risk chemotherapy (LRC) or HRC; however, it was most cost effective for women undergoing LRC at older ages or HRC at younger ages. Although FP-OC results in higher LBRs, it was always more costly. Using donor oocyte IVF can be a successful alternative to autologous FP-OC.

LIMITATIONS REASONS FOR CAUTION

Decision tree results reflect probabilities of certain events and are compiled from multiple reputable sources but are not directly derived from a recruited cohort of patients. Outcomes are based on United States estimates and should be interpreted in the broader context of individual patient diagnoses, treatment care plans and country of origin.

WIDER IMPLICATIONS OF THE FINDINGS

The development of this analytic model will help guide practitioners in their counseling of women from age 25 to 40 years, who are considering FP-OC at the time of cancer diagnosis. It provides a realistic pathway from diagnosis to LB and accounts for the majority of costs and outcome possibilities.

STUDY FUNDING/COMPETING INTEREST(s)

This study was partially funded by a grant from National Institute of Health (NIH)/National Institute of Child Health and Human Development (NICHD) (R01 HD67683) to A.Z.S. There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Authors+Show Affiliations

Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of North Carolina, Chapel Hill, NC 27599, USA.Hematology, University of North Carolina, Chapel Hill, NC 27599, USA.Carolinas Fertility Institute, 2614 E 7th St. Suite C, Charlotte, NC 28205, USA.Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of North Carolina, Chapel Hill, NC 27599, USA.Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of North Carolina, Chapel Hill, NC 27599, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28938728

Citation

Lyttle Schumacher, B, et al. "Modeling of Live-birth Rates and Cost-effectiveness of Oocyte Cryopreservation for Cancer Patients Prior to High- and Low-risk Gonadotoxic Chemotherapy." Human Reproduction (Oxford, England), vol. 32, no. 10, 2017, pp. 2049-2055.
Lyttle Schumacher B, Grover N, Mesen T, et al. Modeling of live-birth rates and cost-effectiveness of oocyte cryopreservation for cancer patients prior to high- and low-risk gonadotoxic chemotherapy. Hum Reprod. 2017;32(10):2049-2055.
Lyttle Schumacher, B., Grover, N., Mesen, T., Steiner, A., & Mersereau, J. (2017). Modeling of live-birth rates and cost-effectiveness of oocyte cryopreservation for cancer patients prior to high- and low-risk gonadotoxic chemotherapy. Human Reproduction (Oxford, England), 32(10), 2049-2055. https://doi.org/10.1093/humrep/dex257
Lyttle Schumacher B, et al. Modeling of Live-birth Rates and Cost-effectiveness of Oocyte Cryopreservation for Cancer Patients Prior to High- and Low-risk Gonadotoxic Chemotherapy. Hum Reprod. 2017 10 1;32(10):2049-2055. PubMed PMID: 28938728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modeling of live-birth rates and cost-effectiveness of oocyte cryopreservation for cancer patients prior to high- and low-risk gonadotoxic chemotherapy. AU - Lyttle Schumacher,B, AU - Grover,N, AU - Mesen,T, AU - Steiner,A, AU - Mersereau,J, PY - 2017/01/25/received PY - 2017/07/22/accepted PY - 2017/9/24/entrez PY - 2017/9/25/pubmed PY - 2018/6/7/medline KW - cancer KW - chemotherapy KW - cost-effectiveness KW - fertility preservation KW - gonadotoxic KW - oocyte cryopreservation SP - 2049 EP - 2055 JF - Human reproduction (Oxford, England) JO - Hum. Reprod. VL - 32 IS - 10 N2 - STUDY QUESTION: What is the live-birth rate (LBR) and cost-effectiveness of fertility preservation with oocyte cryopreservation (FP-OC) compared to expectant management in cancer patients age 25-40 based on estimated gonadotoxicity of treatments 5 years after cancer diagnosis? SUMMARY ANSWER: Oocyte cryopreservation prior to cancer treatment is more costly, yet more effective (producing more live births), than not undergoing oocyte cryopreservation but it is most beneficial for patients undergoing high-risk chemotherapy (HRC). WHAT IS KNOWN ALREADY: The decision to undergo FP prior to treatment is multifactorial and can be costly and delay treatment. Not all treatments carry the same gonadotoxicity and patients may choose to undergo FP-OC based on the probability of premature ovarian insufficiency, predicted outcomes and cost. A comprehensive model that incorporates age at diagnosis and toxicity of treatment to help guide patients in the decision to undergo FP-OC does not yet exist. STUDY DESIGN, SIZE DURATION: This study used a Decision Analysis Model to estimate effectiveness and cost of FP for cancer patients. PARTICIPANTS/MATERIALS, SETTING, METHODS: Age-based estimates of LBR and cost per live birth were calculated for ages 25-40 years based on gonadotoxicity of treatment. A decision analysis model was constructed using Treeage Pro 2015 with case base probabilities derived from national registries, practice guidelines and medical records from a national network of infertility practices (IntegraMed). MAIN RESULTS AND THE ROLE OF CHANCE: Compared to no FP-OC, FP-OC improved LBRs for women of all ages undergoing either low-risk chemotherapy (LRC) or HRC; however, it was most cost effective for women undergoing LRC at older ages or HRC at younger ages. Although FP-OC results in higher LBRs, it was always more costly. Using donor oocyte IVF can be a successful alternative to autologous FP-OC. LIMITATIONS REASONS FOR CAUTION: Decision tree results reflect probabilities of certain events and are compiled from multiple reputable sources but are not directly derived from a recruited cohort of patients. Outcomes are based on United States estimates and should be interpreted in the broader context of individual patient diagnoses, treatment care plans and country of origin. WIDER IMPLICATIONS OF THE FINDINGS: The development of this analytic model will help guide practitioners in their counseling of women from age 25 to 40 years, who are considering FP-OC at the time of cancer diagnosis. It provides a realistic pathway from diagnosis to LB and accounts for the majority of costs and outcome possibilities. STUDY FUNDING/COMPETING INTEREST(s): This study was partially funded by a grant from National Institute of Health (NIH)/National Institute of Child Health and Human Development (NICHD) (R01 HD67683) to A.Z.S. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A. SN - 1460-2350 UR - https://www.unboundmedicine.com/medline/citation/28938728/Modeling_of_live_birth_rates_and_cost_effectiveness_of_oocyte_cryopreservation_for_cancer_patients_prior_to_high__and_low_risk_gonadotoxic_chemotherapy_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/dex257 DB - PRIME DP - Unbound Medicine ER -